What Causes Sciatic Pain, Disc Herniation, and Disc Bulges?

Bad Back? Sciatica? Disc Problems?

I’m Dr. Shawn Phelan. I am here today from Wake Forest Chiropractic in Wake Forest, North Carolina, to talk with you about disc herniation and bulges and sciatica, which is a condition that can be caused by these conditions.

Many of the patients who come to Wake Forest Chiropractic have these conditions, and we thought it would be beneficial of them and you to understand more about them. This knowledge will help you to understand the treatments that may be suggested to you by us or your local practitioner.

Figure 1

Let’s start with this diagram (see Figure 1) of the vertebrae, spinal column, spinal cord, and discs. In simple terms, vertebrae are really not much more than a couple of blocks of bone stacked upon each other, which is what creates our spinal column. The vertebrae are separated by discs (intervertebral discs). The job of the disc is to absorb shock and provide us with stability. Behind the vertebrae and discs is the spinal cord which runs from the brain down to the upper to mid lumbar spine area. Just in front of the spinal cord and right next to the intervertebral disc is the spinal nerve. The spinal nerve leaves the spinal cord and then heads down into the arms and the legs in order to supply the lower and the upper extremities with nerve supply, and the ability to contract and control musculature and activity.

Figure 2

The spinal nerves come in very close proximity to the intervertebral discs. This diagram (see Figure 2) shows what it would look like if we were to look directly down from the top of the spine to see the disc itself. What we would see is bone. This little projection of bone on the top of the drawing is the spinous process. That is the bone that we feel when we push on to the back of our spine. Just in front of that, or below from the perspective of the drawing, is the spinal cord, it is the red circle which runs from north to south in your body. The spinal nerves exit to the spinal intervertebral disc, it is represented here by the horizontal red line, and that’s where the trouble can start if we have a disc herniation.

Figure 3

The black fibrous-looking material surrounding the blue circle is the disc itself. The blue circle is representing a mucoprotein jelly, called the nucleus pulpous, and is designed to further the ability of that disc to absorb shock. What often occurs is that disc itself, the fibrocartilaginous material, can weaken and start to bulge backward toward or even into the nerve root area. That’s called your disc bulge (see Figure 3).

The disc bulge is present in about 30% of the population. Studies have been done which have taken 100 people who have no back pain at all and had them scanned by MRI machines. The results showed that 30% of the people studied who reported no pain or symptoms actually had large disc bulges or disc herniations in their spine.

If you do have sciatica or a disc herniation, the difference between them and you right now is simply inflammation and that inflammation is what is driving your pain. The bulge in the disc can exist for quite a long time causing some low grade back pain that comes and goes, gets better, gets worse. Each time it will come back a little sooner and a little worse. This is classic for the development of a disc problem in your spine.

Figure 4

What can eventually happen, if that goes on long enough, if that inflammation we spoke of continues beyond a certain point, is that you will start to get some radial tearing in the disc material or the fibro cartilage itself. The nuclear matter starts to bulge outward and that is when we start to consider it a disc herniation (see Figure 4).

In some instances what will happen is the outer material of the disc itself will actually tear through and rupture and that jelly can leak outward or even pieces of the disc itself can break off and then start to transit up and down the spine cord area floating around and causing all kinds of trouble. That is called a disc rupture. So we have three terms: the initial bulging, the herniation, and finally the rupture of the material.

How do you know if you are suffering from something that’s related to nerves, muscles, or discs? If you have a disc problem, you are probably going to have a sharp, linear or line-like pain that radiates down the back of the leg into the calf or down the arm into the hand area, or even into the shoulder blade area. Again, it’s probably pain that’s come and gone for a long time. The longer the pain is there, the worst it gets, and it continues to become an issue a little sooner each time.

The bottom line when you get into this situation is that the disc is inflamed. You may feel like it’s a muscle problem, which is normal because the muscles actually contract and splint to protect the body. The muscles may actually pull you into antalgic postures where you will be pulled to one side or the other.

One of the things you need to understand is that just because you are stiff, immobile, and have a muscle spasm; it does not necessarily mean that this is a muscle problem. The muscle spasm may be the result of the disc herniation itself, and this is your body’s attempt to protect you from it.

Without treatment, these conditions often progress and worsen. You may experience progressive pain, progressive neurological deficit, or you may lose motor control. Ultimately, you may end up requiring spinal surgery of the neck or lower back.

At Wake Forest Chiropractic, we have three goals when you visit our office to seek treatment of these conditions.

Pain relief

We will work to make you comfortable and functional so that you can continue with the normal activities of your life.

Restore the function of the spine

Restoring the function of the spine will allow you to move so that the structures are not creating pressure on the nerves.

Strengthening the spine and the musculature will help to make sure that you don’t end up with a chronic situation and have to experience the condition and treatment over and over.

Strengthen the spine and the musculature

Once the inflammation and swelling has been reduced, you can function with a disc bulge or a disc herniation in the spine because the disc is no longer impacting the spinal nerve. And the good news about getting older is that the discs will tend to dehydrate and toughen up as you age. Therefore, even if you’ve had a disc herniation, come close to surgery, or have had to undergo care for this condition, it does not necessarily mean that you a “bad back” or that you will eventually have to have surgery. What it means is that you need to get the discs to a point where the inflammation is under control and they can toughen up naturally as the years go on, and then you should be able to manage your activities without fear of further injury.

If you would like further information on disc conditions and sciatica, please go to our website, http://wakeforestchiropractic.com. To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

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